The pandemic illuminated long-standing health inequities in Hawaii as COVID-19 disproportionately affected Filipinos and non-Hawaiian Pacific Islanders. The Department of Health hopes to reduce those by reestablishing the defunct Office of Health Equity with the help of an infusion of nearly $25 million in federal funds.

The change comes as racial and ethnic disparities in the pandemic persist across coronavirus cases, hospitalizations, deaths and vaccination rates in the islands.

Lola Irvin, who leads the health department’s chronic disease division, said the re-forming of the equity office and expansion of its staff to seven is in response to those disparities.

“We are taking the lessons learned, and we are going to continue to work with the community leaders,” Irvin said. The office is intended “as a way to maintain our focus on how to continue what we’re doing and learn from what happened.”

The defunct Office of Health Equity still has a webpage on the Health Department’s site. Now the office will be revived. Screenshot/DOH website

Currently, Hawaii’s Pacific Islander population — excluding Hawaiians — makes up 20% of statewide coronavirus cases, although they’re just 4% of the population. At some points during the past 15 months, the community made up more than 30% of infections statewide.

The state’s Filipino community also has experienced disproportionately high virus rates: 20% compared with 16% of the population. High coronavirus rates in both communities are driven by many factors, including but not limited to high rates of front-line workers, crowded living situations, barriers to accessing health care and preexisting health conditions.

Longstanding Inequities

The pandemic has underscored not only Hawaii’s health, social and economic disparities but also how the state has fallen short in addressing them.

Just six years before the pandemic, the Ige administration got rid of the one-man Office of Health Equity, whose mission was to “increase the capacity of government, private providers, communities, and individuals to eliminate health disparities and improve the quality of life of Hawaii’s diverse populations.”

That same year, the Ige administration defunded public health insurance for thousands of low-income Pacific migrants, shifting them onto more expensive subsidized private health insurance. University of Hawaii studies found that policy change correlated with a drop in hospital visits, a rise in uninsured emergency room visits and a sharp increase in mortality for the community.

When the pandemic hit, Pacific Islanders were predictably hit hardest. But detailed racial breakdowns in Hawaii’s coronavirus data were relatively slow to emerge. In April 2020, then-Hawaii Department of Health Director Bruce Anderson said he didn’t expect any racial disparities to emerge in Hawaii’s pandemic and downplayed the state’s socioeconomic disparities.

Native Hawaiian and other Pacific Islander leaders felt shut out of the pandemic response and frustrated by the initial lack of disaggregated case data. As the virus spread in Pacific Islander communities, many families couldn’t get help from the state in part due to language and cultural barriers. It took over six months for the state to establish a dedicated contact tracing team equipped with people who spoke a wide range of Pacific Islander and Filipino languages.

Other states and cities had more infrastructure in place than Hawaii to respond to pandemic disparities. In Louisville, Kentucky, the city’s Center for Health Equity staff was formally integrated into the city’s pandemic response. Seattle and Portland also had established health equity officers who helped facilitate communication with marginalized communities.

What The Office Will Do

Over the past year, the health department has improved its data collection and reporting, as well as ramped up communication and outreach to marginalized communities.

The agency also recently released a health equity report analyzing how the pandemic has disproportionately affected non-Hawaiian Pacific Islanders and Filipinos.

Kim Birnie from the nonprofit Papa Ola Lokahi, which is dedicated to improving Native Hawaiian health, said the state’s improved data reporting and disaggregation is a huge achievement that has helped better target resources to address disparities.

Birnie noted Hawaii is the only state that disaggregates Filipinos from other Asians and Native Hawaiians from other Pacific Islanders in COVID-19 data.

“I personally have been talking about data disaggregation for 30 years,” she said. “Data disaggregation is so important, otherwise the true picture of health is masked when we’re lumped together with everyone else.”

She’s excited about the new Health Equity Office, which she said years ago used to be dedicated to Native Hawaiian health.

“I think it’s important to acknowledge the disparities and to acknowledge the core reasons why certain communities continue to experience an unequal burden on health,” she said.

About $2.5 million will be used for two years of funding for the office, with an option to renew for a third year, Irvin said, adding the organization will initially be placed within her chronic disease division and the first year she’ll be in charge of hiring staffers.

The revived Health Equity Office will include a project manager, three epidemiologists and three program specialists. Irvin said she’s also starting to recruit an advisory group.

“This way we will have internal as well as external accountability,” she said.

A big part of the office’s job will involve better data collection and reporting. She noted the office will have a key role in updating race and ethnicity data standards.

The office will also have a role in weighing in on both internal policies, such as hiring and retention practices, and external policies, such as bills at the Legislature that could impact health equity.

More Federal Funds

The Office of Health Equity is expected to take up just about one-tenth of the $24,512,230 grant from the Centers of Disease Control and Prevention. The bulk of the funding — about $10.5 million — will go to COVID-19 prevention, including testing, vaccinations and data collection, Irvin said.

People who identify as Native Hawaiian, Pacific Islander or Black are underrepresented in Hawaii’s vaccination rates, while people of white and Asian ancestry are currently overrepresented. Irvin said the funding will help ensure that the state can fund targeted vaccination efforts, such as at a specific church.

The state still hasn’t released any disaggregated data on vaccination rates for Filipinos separate from other Asians.

Another $9.4 million will go to partner mobilization efforts, including community outreach and public education. Over the past year, the state health department has hired more people who are conducting community outreach with Pacific Islander and Filipino communities and the funding is expected to extend their positions.

Another nearly $2.4 million will go to data collection and reporting.

About $7 million of the money targeted for the above goals will go specifically to the Hawaii state Office of Primary Care and Rural Health, which plans to set up a telehealth program in partnership with state libraries and the state university. The money is also slated to pay for six medical transit vans across Oahu, Maui, Kauai, Hilo, Kona and Lanai, Irvin said. 

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